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Stopping narcotics before surgery

My son's physician wants him to come off of all narcotics (he's on saboxone) for 8 weeks before his upcoming surgery. I don't really understand this reasoning. He does have problems with addiction, thus the saboxone, but it is going to be so hard for him to completely come off of all pain medication that long before the surgery. Has anyone else experienced this? I understand wanting the pain medication to work better post surgery, but 8 weeks of suffering?? Thanks for any comments. He is 24 and looking to have spinal fusion L3 - S1 in June.

If I were you, I'd call the office and try to find out why. My surgery is Monday and the only med I had to stop was meloxicam (anti inflammatory)...I can't imagine not having my pain meds right now. I hope you get some answers for him.

saboxone, or suboxone, is used to treat opiate addiction, is it not....????
i would think this will complicate pain treatment after surgery as well....
does your son have an medical doctor who is an addiction specialist who can discuss his tx with the surgeon who
will be doing the scoliosis fusion surgery....????

Pain Team

Hi,
I can tell you that I have had two huge back surgeries. Thus I have been on pain meds for a long time and never once stopped them before the surgeries. But what I did do, is make DARN sure that my "surgeon" knew that I was on pain meds for a long while , and that I was going to need extra help. Now , the anesthesiologist will accually be in recovery with your son. He will talk to him before hand. Your son needs to make it very clear what his situation is. Anesthesiologist are experts in pain managment. So they are suppose to know what to do in situations like these. Also, a lot of big hospitals accually have "pain teams" that are called in when there's a situation that requires expert pain management. The main thing is that your son should not have to go off of pain meds and suffer before surgery(in my opinion) and should get the best pain relief as anyone else, if the right people are alerted, after surgery! The experts will know what to do as far as what meds to use after his surgery, even if he hasn't stopped his meds. It would be great if we didn't have to take the meds~~but it's the reason we are searching for help , because of our pain and suffering. Good Luck~and remember-he deserves to have the best pain relief they can give~~Linda

I guess I didn't ask if your physician that ask your son to get off pain meds is his surgeon or just his GP? A good pain mngt. Dr. would know how to handle the thing with suboxone and surgery. And that brings me back to the anesthesiologist, as they are suppose to be experts in this field. Just makes me disgusted to expect someone to be in pain for any length of time. Warmly, Linda

Since opiate addiction is one of the things that can be a predictor of poor outcome, the surgeon may feel he has a chance at a better outcome if the patient is off narcotics prior to surgery. I think I may have heard surgeons tell patients to try to reduce their narcotic usage, if possible, but I've never heard of a surgeon asking that the patient stop all narcotics. It seems to me that you could end up with a totally unstable patient that way. I would definitely question the surgeon before even trying to stop.

Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Dilbert
I'm sarcastic... what's your super power? --Unknown
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Surgery 2/10/93 A/P fusion T4-L3
Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation
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Trying to make sense of it all...

Thank you Linda...we need to speak to the physician to find out his reasoning once again. We are dealing with a pain/addiction specialist and he and the surgeon are conversing about the plan. The surgeon (Dr. Nathan Lebwohl) wanted him to be off all narcs before surgery...8 weeks worth of being off! It was the thinking of his pain doc to go on saboxone for 4-6 months before surgery to come off of narcotics. The surgeon is pretty much leaving it up to the pain doc to decide when he is ready to "handle" surgery. Honestly, my son is not handling the idea of surgery well at all. He is so petrified of the surgery. He has had many surgeries in his life from a horrific accident when he was 4 yrs. Most of the surgeries have been on his urinary system. The spinal fusion he had 6 years ago was pure hell. He NEVER stopped hurting and the pain mgt. after was disgustingly bad. It was an awful experience. So...he just isn't handling the idea of going through this huge surgery again. I really think the surgeon is thinking, "get him off the narcs well enough ahead of time, so that the meds will work better after surgery, and also, so that when and if he has "less" pain after surgery, he will be ahead of the imprint the narcs make on the brain and have a better chance of staying off of them." Problem with my son is...he is a disasterous addict and would love to just be numb to life. His back pain and problems is only one aspect of his problems he deals with. The urinary system issue has left him unable to function sexually. That really messes with his mind. IT's just sooooo much, but I agree with you...I think it is going to be very difficult for him to be off all pain relief for 8 weeks before. He is also having to stop smoking during all of this!!! I don't think Dr. Lenke even requires a person to stay off of narcs for this long!!! I wonder Linda...would you be willing to email with my son and do some one on one with him concerning all of this? I'm sure he would be more than willing to talk with you. You seem to have a really good knowledge base of all this spinal surgery world. Let me know, and I so appreciate your help.

I know right.

Originally Posted by babyboomer16

I guess I didn't ask if your physician that ask your son to get off pain meds is his surgeon or just his GP? A good pain mngt. Dr. would know how to handle the thing with suboxone and surgery. And that brings me back to the anesthesiologist, as they are suppose to be experts in this field. Just makes me disgusted to expect someone to be in pain for any length of time. Warmly, Linda

It is the surgeon Linda. he goes to a pain/addiction specialist. The problem with my son is he is not just addicted to narcs, he abuses the heck out of them if given half the chance. It's been a huge problem in the past. The saboxone has been good for him, but doesn't help his pain that much according to him. It is crazy in my opinion to expect him to stay off all narcs for that long, and also he has had to quit smoking cigs also. All at once is CRAZYYYY!!! He has a lot of other problems besides his back. I wish I was God...I would heal him. ;o)

saboxone, or suboxone, is used to treat opiate addiction, is it not....????
i would think this will complicate pain treatment after surgery as well....
does your son have an medical doctor who is an addiction specialist who can discuss his tx with the surgeon who
will be doing the scoliosis fusion surgery....????

jess

He sees a pain/addiction specialist and he is teaming up with the surgeon to come up with this plan for him. Problem is...they are 10 hours apart and conversing by phone and it is difficult to get in touch with the pain specialist. Easier to speak with the surgeon as he gave us his cell phone number. We just need to get up to date on what the two of them are conversing about. It was just today that the surgeon's nurse called and got the pain docs number to call him...again since they misplaced the number. Originally though the pain doc said he could use the saboxone and come off like 2 weeks before the surgery...so I need to find out what their plan is! Soooooo frustrating...on top of the thought of the huge surgery and wondering if it is even going to help him. I wonder what the % of people that really have successful surgeries is? I said before his fusion is from L3-S1, but I meant to say T3-S1!! Thanks for your input!! ;o)

I wonder Linda...would you be willing to email with my son and do some one on one with him concerning all of this? I'm sure he would be more than willing to talk with you.

Of course. I'll PM with my email address and phone number.

Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Dilbert
I'm sarcastic... what's your super power? --Unknown
---------------------------------------------------------------------------------------------------------------------------------------------------
Surgery 2/10/93 A/P fusion T4-L3
Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation
---------------------------------------------------------------------------------------------------------------------------------------------------
If you've signed up and are having trouble posting, please check your spam folder. An email was sent to the email address which you subscribed. You have to follow the instructions in that email. Done that and still having trouble posting? Contact Joe O'Brien at jpobrien@scoliosis.org.

"a disastrous addict" who would just like to be "numb to life" is a whole other level entirely!...
it is not like scoli patients who worry about becoming dependent on the pain meds, use them only for pain, and
are in a hurry to wean off...
real addicts like the stuff...they like anything that can numb feelings...and will use "recreationally"
not just for pain the way surgery patients do, the patients who are always worried about how much they are taking
are not the same as the patient who is an addict before any surgery takes place....

i can see why any surgeon having this young man for a patient would have a lot to worry about...
a lot of dangers not there for non addicted scoli patients....

Dianadee58,
I'm wondering about your son and concerned for him. What I'm wondering is if his addiction problem happened as a result of untreated pain. I worked in a drug and alcohol rehab center many years ago. I would take care of the detoxing patients. It's been my experience, even with my own kids, that addiction to anything stems from trying to self-medicate something, whether it be emotional or physical pain. He may have very well been self-medicating his physical pain and became an addict that way. Addiction tendencies are partly hereditary as well. Some people inadvertantly become addicted to narcotics after a big surgery like this. I feel that he is most "at risk" post-op for becoming dependent on pain killers, and this has ruined many lives of the unwary. However, if he feels better, he may not "need" the pain killers anymore and would just need supportive care from either an addiction specialist or a pain psychologist or both to stay clean. I can't see them withholding a pain pump after surgery just because he's an addict. He's still a human being and is going to have pain initially. Those pumps are programmed NOT to let you have more than a safe level of narcotic as determined by the doctor. For me, it would be the months and years after surgery that I would most worry about. If he's truly in pain, I can not understand them wanting him to be off of all narcotics before surgery, especially if he is following his prescription protocol. Many of us have been on narcotics for years, but are not addicts. I wish you both the best and just wanted to let you know my thoughts.